APPLICATION FORM COVER/FRONT PAGE/INVITATION/ANNOUNCEMENT
Cover: cover of the thesis Front page: black and white copy of the cover, following the cover Invitation: required item to receive the bonus Announcement: After the approval of the PhD student and the UHasselt promoter, the Communication and Marketing office will send the digital version of the announcement to all faculties/schools.
!!! ATTENTION !!!
Submission of this form: at least 10 working days before printing the proof of the thesis Only fully completed form can be processed Send this form to phd@uhasselt.be with the subject: ‘Application form cover – first name, last name – date of defence’ If required information in this form is unknown, please consult your ‘My Doctoral file) (‘MDF’) or contact your promoter/faculty. Administrative Director/contact person per faculty: Faculty of Architecture and Art: Christel Heyninckx/Inge Lens Faculty of Business Economics: Cindy Vankerkom Faculty of Medicine and Life Sciences: Katherine Nelissen/ Véronique Pousset Faculty of Engineering Technology: Machteld Schots/ Diana Olislagers Faculty of Law: Marijke Huber/An Vranken Faculty of Rehabilitation Sciences: Ann Vanderheyden/Els Gennez Faculty of Sciences: Isabel Thys/ Marjan Goossens School of Educational Studies: Heidi Gielen School of Transportation Sciences: Edith Donders/ Kristel Hertogs School of Social Sciences: Ilse Peters For a joint PhD (in collaboration with another university): add the signed joint PhD agreement to this form + the logo of the 2nd university in attachment to the e-mail (format: .jpeg, .eps or .ai) In case of a joint supervision (in collaboration with another institution such as; PXL, Fachhochschule, …): add the signed agreement to this form + the logo of the 2nd institution in attachment to the e-mail (format: .jpeg, .eps or .ai) Please always use the correct titles (according to the style guide) with the names of the promoter(s) and/or co-promoter(s) and the correct affiliation(s).

GENERAL INFORMATION THESIS/DEFENCE
Personal information:	Name: First name: M / F / X:
Thesis A depot number must be requested with Patrick Carmens	Depot number: Number of pages (for determining the thickness of the cover):
Public defence	Day and date: Room: Time: Link for digital live-stream:
COVER/FRONT PAGE
Language of the cover? The cover is written in the same language as the thesis	☐ Dutch ☐ English
Information PhD: These data must correspond with the data in your My Doctoral file *: Please use the correct titles (see style guide1, no deviation possible). For example: Dutch: Prof. – dr. English: Prof. – Dr Add affiliation(s) With a joint PhD or a joint supervision, both the UHasselt logo (and if applicable the tUL logo) + the logo of the partner university / institution are included on the cover. The joint PhD or joint supervision agreement must be attached to this application form.	Type of PhD ☐ UHasselt/tUL PhD ☐ Joint PhD Title thesis: Promoter*: Co-promoter(s)*: Joint PhD extra information: Official name 2nd university 2nd promoter*: Joint supervision extra information: Official name 2nd institution
Indicate the discipline in which you will defend at UHasselt (max. 1): (Dutch abbreviation of the faculty/school) * The transnational University Limburg (tUL) is a cooperation between Hasselt University (Belgium) and Maastricht University (the Netherlands) and can be considered as one university with a home base in each country (http://www.tul.edu/).	Faculty of Architecture and Arts (ARK) ☐ Architecture ☐ Audiovisual and Visual Arts ☐ Tourism Faculty of Business Economics (BEW) ☐ Business Economics ☐ Tourism Faculty of Medicine and Life Sciences (GLW) ☐ Medical Science ☐ Biomedical Sciences (tUL*) ☐ Nursing Science ☐ Tourism Faculty of Engineering Technology (IIW) ☐ Engineering Technology ☐ Tourism Faculty of Law (REC) ☐ Law (tUL*) ☐ Tourism Faculty of Rehabilitation Sciences (RWS) ☐ Rehabilitation Sciences and Physiotherapy ☐ Rehabilitation Sciences ☐ Occupational Therapy Sciences ☐ Tourism Faculty of Sciences (WET) ☐ Sciences ☐ Sciences: Biology ☐ Sciences: Chemistry ☐ Sciences: Physics ☐ Sciences: Information Technology (tUL*) ☐ Sciences: Statistics ☐ Sciences: Mathematics ☐ Sciences: Materiomics ☐ Tourism School of Educational Studies (SES) ☐ Educational Sciences (tUL*) ☐ Tourism School of Social Sciences (SSW) ☐ Social Sciences ☐ Tourism School of Transportation Sciences (SvM) ☐ Transportation Sciences ☐ Tourism
Should one of the following logos be added? If applicable, the logo of an UHasselt research institute or center will be included on the bottem left of the front page – which otherwise is an exact copy of the cover- or on the back cover.	☐ No ☐ Yes: UHasselt research institute or center: ☐ BIOMED ☐ CMK ☐ DSI ☐ EDM ☐ IMOB ☐ IMO-IMOMEC ☐ LCRC
Logo of other institution(s) involved? If applicable, the logo of another involved institution will be included on the second page (back of the front page).	☐ No ☐ Yes: Other institution(s) involved: (Please annex the logo to this form in format: .jpeg, .eps or .ai) ☐ Funding company: ☐ Strategic research center (VITO, IMEC, VIB, iMinds): ☐ Hospital: ☐ Public fund: ☐ Other: ☐ (Only for PhDs of BEW: mandatory inclusion of ‘AACSB Accreditation’ logo)
INVITATIONS/ANNOUNCEMENTS
Subsequent reception:	☐ No ☐ Yes If ‘Yes’ ask for notification of presence: ☐ No ☐ Yes If ‘Yes’, through which channel: ☐ Tel: ☐ Mobile: ☐ E-mail:
Invitations * Orders only possible in specified fixed edition.	☐ Digital ☐ Dutch ☐ English ☐ Printed*: ☐ Dutch: ☐ x6 ☐ x12 ☐ x36 ☐ x50 ☐ x100 ☐ English: ☐ x6 ☐ x12 ☐ x36 ☐ x50 ☐ x100
Announcement	After the approval of the PhD student and the UHasselt promoter, the Communication and Marketing office will send the digital version of the announcement to all faculties/schools.
INVOICE DETAILS
Invoice details * If unknown, please contact your coordination financial cell or the Administrative director of the faculty/school.	Financial cell of your faculty/school: Financial UHasselt account/Order form number*: Further specification:

Available on Intranet/Communication and events/Communicatie/Communicatietips

The logo can be requested from the faculty (rachel.moreau@uhasselt.be or cindy.vankerkom@uhasselt.be)